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Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia

BACKGROUND: Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection...

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Autores principales: Chauffard, Aline, Bridevaux, Pierre-Olivier, Carballo, Sebastian, Prendki, Virginie, Reny, Jean-Luc, Stirnemann, Jérôme, Garin, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066797/
https://www.ncbi.nlm.nih.gov/pubmed/35505308
http://dx.doi.org/10.1186/s12879-022-07423-1
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author Chauffard, Aline
Bridevaux, Pierre-Olivier
Carballo, Sebastian
Prendki, Virginie
Reny, Jean-Luc
Stirnemann, Jérôme
Garin, Nicolas
author_facet Chauffard, Aline
Bridevaux, Pierre-Olivier
Carballo, Sebastian
Prendki, Virginie
Reny, Jean-Luc
Stirnemann, Jérôme
Garin, Nicolas
author_sort Chauffard, Aline
collection PubMed
description BACKGROUND: Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit. METHODS: This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity. RESULTS: Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2–6.2), heart failure (OR 2.6, 95% CI 1.1–6.1), absence of chest pain (OR 3.0, 95% CI 1.1–8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4–6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3–5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71–0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity. CONCLUSION: Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects. Trial registration: NCT00818610.
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spelling pubmed-90667972022-05-04 Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia Chauffard, Aline Bridevaux, Pierre-Olivier Carballo, Sebastian Prendki, Virginie Reny, Jean-Luc Stirnemann, Jérôme Garin, Nicolas BMC Infect Dis Research BACKGROUND: Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit. METHODS: This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity. RESULTS: Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2–6.2), heart failure (OR 2.6, 95% CI 1.1–6.1), absence of chest pain (OR 3.0, 95% CI 1.1–8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4–6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3–5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71–0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity. CONCLUSION: Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects. Trial registration: NCT00818610. BioMed Central 2022-05-03 /pmc/articles/PMC9066797/ /pubmed/35505308 http://dx.doi.org/10.1186/s12879-022-07423-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Chauffard, Aline
Bridevaux, Pierre-Olivier
Carballo, Sebastian
Prendki, Virginie
Reny, Jean-Luc
Stirnemann, Jérôme
Garin, Nicolas
Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
title Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
title_full Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
title_fullStr Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
title_full_unstemmed Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
title_short Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
title_sort accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066797/
https://www.ncbi.nlm.nih.gov/pubmed/35505308
http://dx.doi.org/10.1186/s12879-022-07423-1
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